Sidney W Spencer, O.D.
Individual provider Active NPI Optometrist · Pilot MTN, NC
NPI 1366431439 · NPPES record last updated Mar 26, 2009
Key facts
- NPI
- 1366431439
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- #0951 (NC)
- Practice address
- 118 Golf Course Rd
Pilot MTN, NC 27041 - Phone
- (336) 368-4727
- Fax
- (336) 368-5627
- NPI assigned
- Oct 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111230000019 | NC | Practitioner - Optometry | 5799899019 | Practice locations: Mt Airy, NC |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #0951 | NC | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Williams Eye Associates, OD, PLLC | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0951 | NC | |
| Optometrist | 152W00000X | #0951 | NC | Yes |
Addresses
Primary practice location
118 Golf Course Rd
Pilot MTN, NC 27041
Mailing address
PO Box 607
Pilot MTN, NC 27041
Phone (336) 368-4727
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 79-09862 | Medicaid | NC | |
| 7909862 | Medicaid | NC |
Other providers in Pilot MTN, NC
All providers in Pilot MTN, NC · Optometrist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.